Physician variation in adopting opportunistic salpingectomy at the time of postpartum and interval sterilization for ovarian cancer risk reduction

Objectives

To examine variation in physician adoption of opportunistic salpingectomy (OS) for patients undergoing tubal sterilization.

Study design

Using the Premier Healthcare Database, we identified patients age 18–49 undergoing postpartum or interval sterilization between January 2011–June 2022. Risk-adjusted rate of OS was estimated for each physician-year. Subsequently, we used group-based trajectory models to identify latent groups of physicians following distinct patterns of uptake and examined factors associated with the distinct trajectory patterns.

Results

Among 383,338 postpartum sterilizations (7550 physicians), OS increased from 0.1 % in 2011 to 14.3 % in 2022. Two physician adoption trajectories emerged: low (81.9 % of physicians; rate of OS: 0.049 % in 2011 and 6.1 % in 2022) and high (18.1 % of physicians; rate of OS: 0.02 % in 2011 and 55.3 % in 2022) adoption. Likewise, among 136,965 interval sterilizations (3401 physicians), OS rose from 1.4 % in 2011 to 65.9 % in 2022 with nearly equal number of physicians in the low (50.1 %; rate of OS: 0.6 % in 2011 and 25.7 % in 2022) and high (49.9 %; rate of OS: 0.6 % in 2011 and 95.8 % in 2022) adoption groups. Physicians with these distinct trajectories differed significantly in rural/urban location, geographic region, surgical volume, and patient composition. In particular, a 10-percentage-point increase in the proportion of Black patients was associated with lower odds of high adoption for both postpartum (aOR: 0.89, 95 % CI: 0.82–0.96) and interval (aOR: 0.89, 95 % CI: 0.84–0.94) sterilization.

Conclusions

While OS increased over time, a substantial proportion of physicians remained low adopters. Geographic and demographic differences in adoption suggest potential inequitable access.